Propionic Acids - Non-Steroidal Anti-Inflammatory Drug(NSAID)

The first member of this group to be
introduced into pharmaco-therapeutics was ibuprofen in 1969. All propionic
acids inhibit PG synthesis as well as platelet aggregation (thereby increasing
bleeding time). They are widely used today in the relief of musculoskeletal
disorders, fractures, sprains, and dysmenor-rhoea. Examples include
benoxaprofen, carprofen, fenbufen, fenoprofen, flurbiprofen, ibuprofen,
indoprofen, ketoprofen, ketorolac, loxoprofen, oxaprozin, pirprofen, suprofen,
and tiaprofenic acid.

Angioedema, hives, itching, rash,
and swelling have been reported with therapeutic use. GI distress, nausea, and
epigas-tric pain are the most common adverse effects with therapeutic doses;
upper GI bleeding may occur after acute or chronic ingestion. Oesophageal
stricture may occur with minimal liquid intake. Enteropathy may occur with
chronic ingestion. Effective October 1999, the FDA requires an alcohol warning
on all over-the-counter pain relievers, which includes aspirin, other
salicylates, paracetamol, ibuprofen, ketoprofen, and naproxen sodium. The
statement is as follows: If you drink 3 or more alcoholic drinks every day, ask
your doctor whether you should take ibuprofen or other pain relievers/fever
reducers. Ibuprofen may cause stomach bleeding.

Isolated cases of thrombocytopenia,
agranulocytosis, haemolysis, lymphopenia, and pancytopenia have been reported
after therapeutic use of propionic acids.

Ibuprofen overdoses have been
commonly reported in the literature, while the other members of this group are
less commonly mentioned. Children ingesting less than 200 mg/kg generally are
asymptomatic or have mild effects. Ingestions of 400 mg/kg in children have
been associated with severe toxicity. Therapeutic plasma levels should be
between 20 to 30 mcg/ml.

Overdose of ketoprofen produces only
mild symptoms, based upon reports from Great Britain. Symptoms include vomiting
and drowsiness; ingestion of 5 grams in an elderly male produced no symptoms.

Treatment involves gastric lavage,
activated charcoal, and supportive measures. Monitor for signs and symptoms of
gastro-intestinal ulceration and/or haemorrhage, i.e. stool guaiac test.
Antacids may be of some value in patients with GI symptoms. Patients with
severe epigastric pain, dysphagia or drooling should be evaluated for possible
oesophageal stricture. Management of hypotension, acidosis, and gastrointestinal
bleeding may be necessary. Enhanced elimination using urine alkalinisation or
haemodialysis has not been shown to be of benefit.

Possible complications of use during
pregnancy include delayed labour, complications during delivery, postpartum
bleeding, and respiratory depression in the newborn.